Sword Swallowers Association International
Application for Membership
Please complete all applicable fields with as much information as possible.
(*Fields marked with a red asterisk are required.)

MEMBER INFORMATION
*First Name: *Last Name:
*Stage Name:
*Sex: *Date of Birth:
*Street Address (line 1):
  Street Address (line 2):
*City: *State:
*Zip Code: (Postal Code) *Country:
       
CONTACT INFORMATION
*Main e-mail:   Other e-mail:
*Telephone: *Mobile cell:
       
NETWORKING INFORMATION
Blackberry Messenger PIN Blackberry PIN: Skype Skype:
AOL AIMAOL AIM: Google GTalkGTalk:
ICQ IM ICQ IM: Yahoo IM Yahoo IM:
Twitter Twitter: MSN Messenger Messenger:
       
*Main website: Blog or other site Other site/blog:
MySpace MySpace: Facebook Facebook:
Linked In Linked In: Plaxo Plaxo:
       

YOUR PERFORMANCE HISTORY
How long have you been swallowing swords?
What year did you begin swallowing swords? At what age?  
How did you learn sword swallowing?
(check all that apply)
Self Taught  
Book or Article
Another Sword Swallower
Other Resource




Who have you successfully taught sword swallowing to?   What year?    
Currently performing sword swallowing shows?
Where or with whom do you currently perform?  
Name:
URL:
Name:
URL:
Name:
URL:
Maximum number of swords swallowed at one time:    
Longest blade swallowed:
Favorite sword to swallow:
What other specialties do you perform? (check all that apply)
Swallow neon tube Eating Glass Hypnotism
Swallow curved sword Walking on Glass Comedy
Swallow Kriss blade Walking on Hot Coals Juggling
Swallow Scissors Bed of Nails Unicycle
Human Blockhead Electrocution Stilt walking
Fire-eating Body piercing with skewers Snake Charming
Fire-breathing Weight lifting with body piercings Belly Dancing
Eating insects Magic Heavily Tattooed
Other:
Are you interested in potential bookings through SSAI?

Profile Permissions
As part of your membership to SSAI, you will be listed on the list of Living Sword Swallowers on www.swordswallow.com. Before including information about you on the list of Living Sword Swallowers, we would like to know which material you would like us to use, and which you would like to keep private. SSAI does not sell or otherwise distribute this information. This information is for our private records and for a link to your listing on the web. We will keep any information that you deem private fully confidential.

* SSAI may publish my...:

Picture Real Name Contact Address
Contact Phone Contact Fax  

SSAI reserves the right to publish your email address, website url, stage name, state/province/region and country on the member profile pages.

In addition, you may include a small series of links to other websites that are related to you and your performing on your profile page. Many people choose to offer links to the troupes that they perform with. Please enter any links that you would like to include on your profile page below: Enter the website address in the URL field and what you want the link to read as in the link text field.
URL:
Link Text:
URL:
Link Text:
URL:
Link Text:
URL:
Link Text:


Your profile may contain a short description of you or your show.
Please enter your profile/bio information below:


Suggestions and Comments


Benefits from SSAI: (What would you like to get out of SSAI?)

Suggestions for SSAI: (What would you like to see SSAI do?)


Contributions to SSAI: (What can you do to help SSAI? Regional Advisor? Lecturer? Marketing?)

Please feel free to submit any additional comments.
   
SSAI Membership Benefits
As an SSAI member, you can get a prestigious swordswallow.org e-mail address that you can use to let people know you are a sword swallower, with all e-mails forwarded to the e-mail address of your choice. There are no logins or passwords to remember, as it is just a forwarded address to your regular email address. This is one way that SSAI members can be contacted without exposing their real email addresses to spammers, while still allowing you the freedom to reply to booking requests or other inquiries from your regular email address.
Preferred e-mail address: @swordswallow.org
E-mail address to forward to:
T-Shirt Size:  
   
   
Emergency Medical Information
*Blood type: *Known Allergies:
   
*Emergency Contact Name, Relationship: *Emergency Contact Telephone:
   
*Doctor Name: *Doctor Telephone:
(We will do our best to fit as much emergency medical information on your SSAI ID Card as possible, but we reserve the right to edit for space)
   
   
   
YOUR ID IMAGES - VERY IMPORTANT!
   
* YOUR ID PHOTO  
Submit 2-3 digital images of your face with sword down your throat against a plain or white background with your face visible. Save as either .gif or .jpg files labelled in order of preference as

  YourName_ID_Photo1.gif   or   YourName_ID_Photo2.jpg

Click here to submit 2-3 digital headshot images
Sample ID Photo showing face with sword against white background
   
* YOUR SIGNATURE  
Submit your signature in black Sharpie on plain white unlined paper. Save as a .gif file labelled

  YourName_ID_Signature1.gif   or   YourName_ID_Signature2.gif

Click here to submit a scan of your signature
Sample signature in black Shapie on plain white unlined paper
   
Instructions:
When submitting your photos and signature, make sure to label the files with your name, a brief description, and designate your first, second and third choices by order of preference using numbers, such as:

YourName_ID_photo1.jpg
YourName_ID_photo2.gif
YourName_ID_photo3.jpg
YourName_ID_signature.gif
   
   
* IMPORTANT:
We will NOT be able to create, complete, laminate and ship your SSAI Membership ID card and t-shirt to you until we have received ALL of your required information such as ID photo, signature, emergency contact, and other pertinent information. The biggest holdup we often encounter in creating and getting your card to you is not receiving the information and images needed from you to create your ID card. Please make sure to submit ALL required information as soon as possible, as we will NOT be able to process your SSAI Membership ID card until you do.

Once you have completed all required information, please
click the button below ONCE to submit your information.
(Please be patient - it may take a moment to submit)

We will get back with you as quickly as possible after receiving your information.
Since each ID card must be individually designed, please allow 6-10 weeks for delivery.



Please click the button below ONCE to submit your application.
(Please be patient - it may take a moment to submit)